High-dose intravenous gamma globulin improves responses to single-donor platelets in patients refractory to platelet transfusion

Abstract

Ten patients, with bone marrow failure or malignant disorders, became refractory to platelet transfusions using random, as well as partial or fully HLA-matched, single-donor platelets. To determine its effect on platelet refractoriness, intravenous gamma globulin (IV IgG) was administered at 400 or 800 mg/kg/d for five days, and postinfusion platelet responses were monitored. Platelet transfusion responses following intravenous gamma globulin (IV IgG) were graded as follows: Excellent, 48-hour posttransfusion count greater than 50,000/microL; good, 48-hour count greater than 20,000 but less than 50,000/microL; Fair, increased increment, 48-hour count less than 20,000; and failed, no increased increment. Six of ten patients (60%) had improved responses to selected single-donor platelets (two were excellent, three were good, and one was fair). The time to achieve a platelet transfusion count greater than 25,000/microL ranged from one to nine days of IgG therapy. One individual had sustained benefit (greater than 1 year); the remaining responses persisted for 6 to 8 weeks. These results suggest that IV IgG may be useful in the management of platelet refractoriness, especially in patients receiving single-donor platelets.

Use of Platelets and Other Transfusion Products in Patients with Malignancy

“…Other approaches that have been tried include highdose immunoglobulin infusions given prior to platelet transfusion, which has been of limited success, and epsilon-aminocaproic acid (12 to 16 gm/day in divided doses) which has been shown to decrease mucosal bleeding. 12 There are strategies available for the potential prevention of PA. The use of HLA-A,B identical platelets will prevent or delay the development of alloimmunization in most patients.…”

Adult‐onset cyclic bicytopenia: A case report and review of treatment of cyclic hematopoiesis

“…Severe thrombocytopenia and bleeding complications can be treated with platelet transfusions. Patients refractory to platelet transfusions may respond to intravenous administration of high-dose gamma globulin followed by single-donor platelet transfusion [45]. Quantitative and qualitative determination of lymphocyte subsets may identify subgroups amenable to immunosuppressive therapy with steroids or cyclosporine [22,3 11.…”

Prevention and management of transfusion-induced alloimmunization: current perspectives

“…22 When PLT refractoriness has developed, patients with bone marrow failure and a PLT count 10,000/µL are in a life-threatening situation. 26 In this situation, the patient's immune system can be modulated by administration of high-dose immunoglobulins to slow down PLT sequestration by the reticuloendothelial system. 26 On the product side, there is the possibility of using HLA-matched products.…”

“…26 In this situation, the patient's immune system can be modulated by administration of high-dose immunoglobulins to slow down PLT sequestration by the reticuloendothelial system. 26 On the product side, there is the possibility of using HLA-matched products. 22 This can be done by searching for donors bearing the identical HLA-A and HLA-B antigens as the PLT recipients.…”